ARI SHAPIRO, HOST:
Republicans are facing a conundrum. They want to cut taxes in their One Big, Beautiful Bill, but those tax cuts would substantially increase the federal debt. So they've been looking for spending cuts, including - especially - Medicaid, the government health insurance program that serves more than 75 million Americans. The conundrum, Medicaid is widely popular, including among many Republican voters. So how can they cut Medicaid while sheltering themselves from the political fallout of cutting Medicaid? Greg Rosalsky, who covers economics and writes our Planet Money newsletter, has been looking into one answer.
GREG ROSALSKY, BYLINE: That answer? Work requirements. Draft versions of the One Big, Beautiful Bill would force millions of able-bodied, working-age adults to work in order to receive Medicaid.
KEVIN CORINTH: I certainly think it's reasonable to impose work requirements for Medicaid.
ROSALSKY: That's Kevin Corinth, a senior fellow at the American Enterprise Institute, a conservative think tank. He says he supports Medicaid, but he says it also makes sense for able-bodied, working-age adults on the program to work if they can. This nudge to work could not only save taxpayers money, he says it could ultimately prove to be beneficial for this nonworking population. Getting a job might help them achieve greater prosperity for themselves or their families.
CORINTH: And I think there could be some important employment increases among this population.
ROSALSKY: However, the majority of people on Medicaid already work, and those who don't are often disabled or elderly or kids or have issues that adding work requirements to a government program won't usually help with. The One Big, Beautiful Bill includes exemptions for groups like that. Then how will these work requirements have the effect of cutting program costs?
DONALD MOYNIHAN: The largest effect is to get people who are working and put them in a situation where they're caught in this administrative trap that they simply can't get around.
ROSALSKY: That's Donald Moynihan, a professor at University of Michigan's Ford School of Public Policy. He's a leading scholar of something known as administrative burdens, basically a paperwork trap that makes it hard for people - especially low-income people - to sign up for or stay on social programs that they're eligible for.
MOYNIHAN: And so they tend to lose benefits even though they are actually fulfilling the requirements. It's the paperwork that catches them.
ROSALSKY: Moynihan's research suggests that work and other eligibility requirements achieve a lot of cost savings by kicking legitimate beneficiaries off the program.
MOYNIHAN: Bureaucracies can often generate administrative burdens inadvertently, but they can also be deliberately created by policymakers who want to reduce the cost of programs by making it more difficult for people to access them.
ROSALSKY: The way Moynihan sees it, lawmakers may be deliberately creating administrative burdens in the One Big, Beautiful Bill to cut Medicaid in a sort of sneaky way, creating red tape that makes it hard for people to obtain benefits. Basically, a cut by another name. But conservatives like AEI's Kevin Corinth point out that work requirements are broadly popular, including with many Democrats.
CORINTH: At the end of the day, it's just sort of a trade-off. If you want work requirements, you're going to have to have some red tape. There's just no way to really avoid that.
ROSALSKY: The Congressional Budget Office estimates that work requirements could cut Medicaid by hundreds of billions of dollars.
Greg Rosalsky, NPR News.
SHAPIRO: And you can read more from Greg Rosalsky by subscribing to the Planet Money newsletter at npr.org.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.